Immunodiagnosis of Celiac Disease among Children with Chronic Diarrhea in Gaza Strip

Abstract

Celiac disease (CD) is a permanent intolerance to gluten that results in damage to the mucosa of the small intestine. This damageconsists of mucosal inflammation and loss of absorptive surfacearea and is manifested by a broad spectrum of symptoms and nutritionaldeficiencies. The immune mediated damage to small bowel mucosa triggered by an immune response to the gliadin fraction of gluten, a component of wheat, barely and oats. CD can present at any age after the introduction of gluten into the diet. During Infant and childhood CD can present with failure to thrive, vomiting, diarrhea, constipation, rickets, occipital seizures, and short stature. In adults, CD may present with iron-deficiency anemia, diarrhea, infertility, nausea, vomiting, abdominal pain, weight loss, and pathologic fractures. CD is associated with specific MHC class II alleles that map to the HLA-DQ locus, The HLA-DQ2, DQ8 alleles associated with increased susceptibility to CD. Since there are no previous studies performed to evaluate the CD in our area, therefore this study was performed to determine the occurrence of CD among children suffering from chronic diarrhea in Gaza City, to investigate the role of ASMA in false negative EMAs results, to propose TTG as an alternative solution for masking problem and To highlight the CD in Gaza Strip for the first time. The results of this study by using EMAs test showed an occurrence of CD (3.25%), but when they were analyzed by using (TTG IgG, IgA) the occurrence was (12.2%), Our results also showed that the occurrence of ASMA was (28.5%), which may mask the EMAs antibodies and hence giving false negative results of EMAs, the four positive subjects for EMAs showed positive results when they were tested for(TTG IgG, IgA), these results mean that the two tests have the same sensitivity, and finally our finding showed that the total IgA deficiency represent (33.3%) from all (TTG IgG, IgA) positive subjects, these results showed false negative results for (TTG IgA), so the class IgG of EMAs and TTG must be done to CD patients with total IgA deficiency. It is recommended to follow the protocol in figure 6.1 for laboratory diagnosis of CD, to Introduce the genetic analysis of CD to identify persons with increased risk of having the disease, and to adopt HPE as a golden standard test for clinical assessment of the patients with CD and to confirm the disease diagnosis.........